Curriculum

Mayo Clinic Rochester Pain Clinic (7-8 months required)

Pain medicine trainees always work under the direct supervision of the pain medicine program director and pain clinic faculty. Trainees participate in the evaluation and treatment of patients with a wide variety of pain problems including cancer pain, spine pain, sympathetically mediated pain, head and facial pain, neuropathic pain, visceral pain, and myofascial pain. Most patients are seen as direct referrals from other Mayo Clinic physicians or from physicians at Mayo-affiliated facilities. Trainees are expected to completely evaluate their patients and present their findings and treatment plans to pain medicine faculty.

Typical treatment plans may involve behavioral modification/psychological testing and treatment, interventional pain procedures, medications and physical modalities. Fluoroscopically-guided interventional pain procedures are performed either at the Gonda Outpatient Procedure Center or in an operating room at Rochester Methodist Hospital.

Services not physically located in the Pain Clinic (such as diagnostic radiology and the autonomic nervous system laboratory) are readily available on the Mayo Campus.

Trainees implement treatment plans and follow their patients under the direct supervision of faculty.

Pain medicine trainees also have the following rotations available:

Anatomy Dissection Laboratory (1 week required)
An anatomy course is organized specifically for pain medicine trainees and conducted on an annual basis. Fellows are asked to dissect anatomical areas of interest that are relevant to pain medicine training and practice. Pain medicine trainees and faculty subsequently meet in the Anatomy Laboratory to review the dissection with the assistance of an anatomy faculty. Anatomy dissection conferences are conducted during the spring quarter each year.

Anesthesia Skills Training (1-2 weeks required for non-Anesthesia-based trainee)
Trainees will be able to prevent, recognize, and treat immediate and potentially life-threatening complications that can occur following interventional pain management techniques.

Hospital-Based Pain Services – Saint Marys Hospital (1-2 weeks required)
Trainees learn how to evaluate postoperative pain patients, manage complications, and, most importantly, how to organize and safely manage a hospital-based pain service. All hospital-based pain service activities are directly supervised by pain medicine faculty.

Palliative Care (1 week required)
Trainees will gain experience in managing palliative care patients and will understand how to identify and manage imminently dying patients. They will also appropriately assess and treat pain, employing excellent, evidence-based pain management techniques, including differentiating type, severity, etiology, and approach to pain.

Pain Rehabilitation Unit (2 weeks required)
Trainees learn to identify patients who may benefit from a behavioral rehabilitation approach to chronic pain. They are also exposed to various psychometric testing procedures, rehabilitative approaches to therapy, and gain experience in identifying and treating patients with substance abuse and dependence issues. Trainees work under the supervision of the medical director of the Pain Rehabilitation Unit during this rotation.

Spine Center (1 week required)
Trainees improve musculoskeletal examination skills, improve skills in interpreting radiographs, CT, MRI and other imaging studies of the spine, and learn to order and interpret nerve conduction/electromyographic studies. The spine center is a multidisciplinary facility. Trainees work under the direct supervision of spine center faculty that includes neurologists, orthopedic surgeons, neurosurgeons, physiatrists and others.

Electromyography (EMG) (1-2 weeks elective)
Trainees will perform routine and complex nerve conduction studies (NCS), needle EMG, and evoked potentials independently and be capable of practice within an academic clinical neurophysiology laboratory.

Fibromyalgia Clinic (2-day elective)
Trainees will gain experience in managing fibromyalgia patients.

Hand Clinic (1 week elective)
Trainees are exposed to the evaluation and treatment of common hand problems. They review the basic anatomy and innervation of the hand and upper extremity to facilitate understanding of upper extremity neural blockade. They also learn to identify hand problems that may respond to surgery. Trainees are directly supervised by faculty hand surgeons during this rotation.

Headache Clinic (1-2 weeks elective)
Trainees will develop the necessary knowledge, attitudes, and skills required to diagnose, manage, and appropriately refer patients with head and/or face pain.

Hospice/Palliative Care (1 week elective)
Trainees learn basic concepts of hospice care including eligibility and certification; cancer pain and symptom management in terminal patients; and ethical issues related to death and dying. Information about palliative sedation, depression and anxiety are taught during this rotation. Trainees are supervised by faculty specialists in palliative care during this training.

Pain Clinic-Mayo Clinic in Florida (4-8 weeks elective)
Trainees gain exposure to additional pain faculty and are exposed to a somewhat different case mix during this rotation. All activities are directly supervised by pain medicine faculty.

Pediatrics (one day every week for one month elective)
Trainees will gain experience in managing pediatric patients.

Regional Anesthesia (1-4 weeks elective)
Trainees gain additional experience with regional anesthesia techniques useful in the care of pain patients during this rotation. This includes instruction about the indications, contraindications, complications and techniques of various nerve blocks. All activities are directly supervised by anesthesiology faculty.

Spine Center (1-2 weeks elective)
Trainees improve musculoskeletal examination skills, improve skills in interpreting radiographs, CT, MRI and other imaging studies of the spine, and learn to order and interpret nerve conduction/electromyographic studies. The spine center is a multidisciplinary facility. Trainees work under the direct supervision of spine center faculty that includes neurologists, orthopedic surgeons, neurosurgeons, physiatrists and others.

The Center for Pain and Supportive Care, Scottsdale, AZ (4-6 weeks elective)
Trainees gain exposure to additional pain faculty and are exposed to a somewhat different case mix during this rotation. All activities are directly supervised by pain medicine faculty.

Neuroscience Course
Pain medicine trainees with interests in basic neuroscience are encouraged to participate in the Mayo Graduate School Neuroscience Course. This course includes more than forty conferences per year. Presentations are made by basic science and clinical faculty with interests and expertise in this field.

Mayo Graduate School of Medicine and Mayo Graduate School also conduct courses in the conduct of human and basic scientific research. Interested pain medicine trainees have the opportunity to participate in these courses on an elective basis.

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